CHRONIC OTITIS-MEDIA REQUIRING VENTILATION TUBES IN TRACHEOTOMIZED VENTILATOR-DEPENDENT CHILDREN

The occurrence of sinusitis and middle ear effusions has frequently be en attributed to the obstruction of the sinus ostia and/or eustachian tube. In the intensive care unit setting, edema caused by the irritati on from nasogastric, nasotracheal and orotracheal tubes has been assoc iated with this pathology and has been responsible for occult sepsis i n this population. Our investigation was performed to determine the ri sk of chronic otitis media with effusion necessitating myringotomy wit h tympanostomy tubes among tracheotomized, ventilator dependent childr en in a consecutive series of children admitted to our recently create d stable ventilator unit. We retrospectively reviewed the medical reco rds of all tracheotomized, chronically ventilator dependent children < 48 months of age who had been hospitalized in this unit from the init ial opening in September 1990 to January 1993. Data collected consiste d of patient demographics, gestational age, cognitive abilities, age a t onset of mechanical ventilation, age at tracheostomy, age at myringo tomy, presence of nasogastric and gastroenterostomy tubes and evidence of gastric-esophageal reflux. All children underwent a tracheostomy p rocedure subsequent to the onset of mechanical ventilation. Of these p atients, 9/12 (75%) later required myringotomy with tympanostomy tube placement following the occurrence of chronic otitis media with effusi on. Ventilation tubes for chronic otitis media with effusion were not required in 3 patients. Using a case control study design, we examined the need of myringotomy tubes for children requiring continuous mecha nical ventilation versus those requiring night-time only ventilation. The risk of myringotomy tubes in the continuously ventilated group (9/ 9) was significantly greater than the risk in the intermittently venti lated group (0/3) P < 0.01. We conclude chronic otitis media with effu sion is a common findingamong preschool-aged children who are tracheot omized and ventilator dependent. Routine periodic ENT evaluation may b e indicated in all pediatric patients who require chronic mechanical v entilation. In this specific population of children, there may be a su bset of patients who would benefit from prophylactic antibiotic therap y or tympanostomy tube insertion during the duration of positive press ure ventilation. Further prospective study is warranted.